Women in their forties have a high rate of unplanned pregnancies. In some cases a midlife baby comes along because a woman mistakenly assumes she is no longer fertile and stops using birth control prematurely. Or a woman who has previously been successful at charting her fertile periods and using birth control during those times learns, through an unanticipated pregnancy, that she can no longer accurately predict when she is ovulating because her cycle is now irregular.

“I was a ‘change of life’ baby myself,” says Linda, 40. “My mother was forty-two when she had me, and I know I wasn’t planned. My oldest brother is going to be 60. I’m just getting to the point where my own children are a little more independent now that they’re eleven and thirteen. They still need plenty of supervision, but as long as I know where they are and whom they’re with now, I can be comfortable letting them plan something for a weekend afternoon. I want to be sure I don’t have a surprise baby like my mother did.”

We may look at our birth control options differently in our forties than we did when we were younger. Many forties women tell me they would like to switch their form of birth control but don’t know of another option that suits their lifestyle. Others ask if they can stop using it altogether, to which I always respond, “Only if an unplanned pregnancy would be acceptable.”

Some health care practitioners prescribe low-dose oral contraceptives, with their combination of estrogen and synthetic progestin, to manage perimenopausal symptoms. These low-dose birth control pills may be a good option for women who find that they relieve their hot flashes or night sweats and who also do not wish to become pregnant. For them, a birth control choice serves the dual purpose of providing perimenopausal symptom relief as well. But for many women the synthetic hormones in oral contraceptives have unpleasant side effects, such as weight gain, mood changes, and insomnia. For these women, birth control choices can be difficult. A barrier form of birth control, such as a condom and/or diaphragm, is probably the best choice, short of a vasectomy for their partner.

The forties may also be a time when our attitudes about birth control change. Some women in their forties tell me they’re tired of taking full responsibility for birth control and wish their husbands would use condoms or have a vasectomy. But old habits die hard, and they’re not sure how to broach this subject. I usually recommend framing this conversation in terms of shared responsibility, an approach Tammy found useful. She had been using a diaphragm for years, but in recent months she found it more annoying and messy than she had in the past. She also thought the diaphragm might be partly responsible for the bladder infections she had had this year. It’s true that a diaphragm is sometimes linked to an inflammation or infection that affects the bladder, and during our forties, when vaginal tissue becomes more susceptible to infection, this can happen more often.

“When you talk about this with your husband, rather than focus on the fact that you’re tired of using the diaphragm, talk first about how you love being close with him,” I recommended to Tammy. “Then you can turn the discussion toward your desire that your husband share the responsibility for birth control by letting him know you’d like a feeling of freedom and spontaneity occasionally too.”

Neither Tammy nor her husband was ready to go for surgical sterilization through tubal ligation or vasectomy, but they did reach a compromise where they would alternate between using a condom and a diaphragm. “We decided to try it month by month and see what happens. We thought it would be tedious to try to keep track of whose week it was, so we’ll try the thirty-day plan.

“My husband wasn’t thrilled at first, but I told him this was important to me. We ended up making a deal as a kind of joke to break the tension,” Tammy said. “I told him that during the months when he had to be in charge of buying and using birth control, and I didn’t have to bother with the diaphragm, I’d probably feel like making love twice as often. He liked that idea.” Tammy is accustomed to using spermicidal with her diaphragm, but I suggested that her husband look for condoms with spermicidal in the tip for more protection, since they don’t want to have more children.

It’s important for women in their forties who do not want to become pregnant to have adequate birth control, even if their menstrual cycle has become irregular. We have a lot going on in our forties, physical and emotional changes, family milestones, career crossroads. If an unplanned pregnancy would be okay with you, you can be sporadic about birth control. But if a pregnancy would add an element of uncertainty or even risk into an already complex decade, be sure that intercourse is protected.

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2. The Basics of Sensuality and Intimacy During Our Forties and Perimenopause

3. The Basics of Pregnancy – Older or Younger Mother?

4. The Basics of How You and Your Baby Grow during Pregnancy

5. The Basics of the Shape of a Woman’s Body in Her Forties

6. The Basics of Uterine Fibroids during Pregnancy

7. The Basics of What You Need to Know About Breast Health in Your Forties

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